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A reliable and simple method for identifying at start patients with tuberculosis of the spine suitable for ambulatory chemotherapy

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Author(s): Sriram K | Somasundaram P | Parthasarathy R | Chandrasekaran V

Journal: Indian Journal of Orthopaedics
ISSN 0019-5413

Volume: 40;
Issue: 3;
Start page: 160;
Date: 2006;
Original page

Keywords: Spinal tuberculosis; Choice of treatment method; Ambulatory chemotherapy; Out-patient treatment; Angle of kyphosis; Discriminant analysis.

ABSTRACT
Background : Ambulatory chemotherapy is very effective in the treatment of spinal tuberculosis, involving vertebral bodies, without paraplegia. However, some patients with thoracic disease could develop worsening of kyphosis. It would be helpful to predict which patients were unlikely to develop severe kyphosis. Methods : Step-wise discriminant analysis on the 10-year data of 79 patients treated with ambulatory chemotherapy showed that the angle of kyphosis on admission and the site of the lesion were associated with an angle of 50 0 or less at 10 years. An equation based on these factors was evolved to give a discriminant function (D) value. Results : Of 51 patients with an angle of 50˚ or less at 10 years, 47 had a D value of 0.499 or less, giving a predictive accuracy of 92%. Of 28 patients who had an angle of more than 50˚ at 10 years, 5 had a D value of 0.499 or less (false-negativity of 18%). Considering the initial angle, which was much more important (p< 0.0001) than the site of the lesion (P< 0.03), 46 of the patients with an angle of 50˚ or less at 10 years had an initial angle of 30˚ or less (predictive accuracy of 90%); 3 of the patients who had an angle of more than 500 at 10 years had an initial angle of 30˚ or less (false-negativity of 11%). Conclusion : If the angle of kyphosis on admission is 300 or less, ambulatory chemotherapy could be confidently prescribed. The method is reliable and simple.
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